[losul]

It confirms what i’ve been thinking too. Also that his infestation may be worse than what rudimentary examination would have led the vet to believe. Could the trembling episodes have actually been a sympton? I only saw find one vague reference online to that. oh sheez

[losul]

Shawna, i’m going to try to compose myself and call the vet back to get him in for X-rays? Woiuld you think the bloodwork already done is enough? It has ALP 23 ALT 48 TOTAL PROTEIN 7.0 BUN 27 CREATININE 1.1 GLUCOSE 91 HEMOLYSIS INDEX 1+ LIPEMIA INDEX N WBC 13.3 RBC 8.13 HGB 19.3 HCT 55.5 MCV 23.7 MCH 23.7 MCHC 34.8 NEUTROPHIL 6663 LYMPHOCYTE 4456 MONOCYTE 718 EOSINOPHIL 1450 BASOPHIL 13
T4 1.7.

I w also wondering why no urinalysis. was done

[losul]

the ESINOPHILS and the HCT whatever they are, are the only ones I see that very near the top of the normal range, if I see this right.

[losul]

It looks like the combined panel tests were a group called “Young Preanesthetic Plus”

Are any of those liver values?

[Shawna]

I’m not sure I’m following losul.. It takes six months, per those sites, for heartworm larvae to mature to adult worms and make offspring. So if heartworm babies, microfilariae, were detected in the blood than he’s had the infection for at least six months now.

I agree that he couldn’t have been infected after the last heartworm dose was given. It would have happened several months before then or there couldn’t be detectable microfilariea.

I’m also not sure that giving extra doses of a drug that heartworm are “resistant” to is going to improve the outcome? Either they are resistant or they aren’t. Giving antibiotic resistant bacteria extra doses of the antibiotic they are resistant to doesn’t improve resistance. Not sure why it would in heartworm either? Seems to me like a ploy to sell more preventative.

You wrote “New adults could still move in after the old ones die”… That is true but NOT in the winter when mosquitos aren’t active. Heartgard kills the L1, L3 and L4 stage heartworms but not L5. The adulticide kills the L5 (and maybe late stage L4?). But L1 microfilariea swimming around in the blood CAN’T become adult worms without first being sucked up by a mosquito where they transform from L1 to L3. The only way for Turbo to get new adult worms is if he gets bit by L3 carrying mosquitos— which won’t be happening now. They would give heartgard or another product that kills L1-L4 in advance to assure that all L3 and L4 maturing larvae are killed and the adulticide to kill the adults. The circulating L1 are not a threat to Turbo unless they are first transformed by a mosquito but they too would be killed by the preventative. If I’m not being clear — at this very moment in time, he can’t get any new adult worms unless he is bitten by a mosquito carrying stage L3 larvae. And that would be RARE to happen in cold temps. All you have to worry about is the small load he has right now… Again, this is one of the reasons why I think Turbo is a good candidate for fast kill. We know the worm load is low and will be when the adulticide is administered AND Turbo is in very good health…

• This reply was modified 11 years, 4 months ago by Shawna.

[Shawna]

And, as Dori stated so well, there is really no way to know for sure what happened — refrigeration, splitting the drug, resistance etc.. Don’t blame yourself.. Know that you caught it early and Turbo is in the best situation possible for clearing these with no residual problems.

[losul]

Shawna I’m not following exactly why you think the worm load is low. I follow all else, but not sure why that?

[Shawna]

I thought your vet specifically told you the adult worm load, currently in the heart, was low or minimal. Did I make that up in my mind? 🙂 If yes, probably not the first time I’ve inserted info where it wasn’t….

[Shawna]

Just saw your bloodwork question. Eosinophils are white blood cells (part of the immune system) that help fight of parasitic infections (like worms). They can also be seen with allergies/intolerances. I’m not surprised to see them high and I would think that the fact that they are not above normal, in an otherwise healthy dog, is a very good sign.. Aimee, Patty, HDM or anyone else have any thoughts on that comment?

Higher HTC shows increased production of red blood cells but I’m not sure how that would pertain to heartworm infection, if at all? First I would check past blood evals to make sure this isn’t his normal and not elevated at all.

As far as other blood work or a urinalysis —- sorry, no help there… 🙁

[Shawna]

Dori,

Losul mentioned some time ago that milk thistle given too early after a heartworm preventative may interfere with the preventative (either by increasing or decreasing efficacy). Neither of which we would want to happen… I don’t think we ever decided when would be the optimal time to give the milk thistle — two days after, a week after etc? It would also depend, I’m sure, on what product is used and how it works.

[losul]

No, he told me there was no real way of finding out, (except surgery) and that X-rays/ultrasound might not really even be able to really tell anything unless it was advanced/really advance. I asked him about the the microfilaria load, and he said something like there are a fair amount, whatever that means, but He said that was no real indicator either as to the number of worms. He did describe his state as class 1, or stage 1, can’t remembrer. But I don’t even know how he could say that for sure without appropriate diagnostic tools. Just listening to his heart and lungs, I don’t know how.

[Dori]

Thanks Shawna. I must have misread or am remembering incorrectly about the Milk Thistle. I thought I was suppose to start the day after and continue for a week. I’ll do research and try to figure it out. For now I’ll stop the Milk Thistle. I’ll check out the Forums maybe someone started the topic somewhere.

[losul]

yes it’s metabolizede by a certain enzyme i forgot what the number right now P something I think. Milk thistle is known to interfere with that liver enzyme, I think it could actually cause the ivermectin to be retained in the system longer than it would otherwise. I’ll have to look back into that, when I get a chance. and also find the actual normal 1/2 life of ivermectin in the body again. I’m thinking off the top of my head it’s more than 90% gone after 2 days. I think I wouldn’t want to give milk thistle too early.

There’s also a number of other drugs it interferes with the normal metabolism.

• This reply was modified 11 years, 4 months ago by losul.

[Shawna]

Hmmm Losul, I think I’d want the x-ray or ultrasound for sure then.. As Patty said, even if it shows nothing it tells you something. I know I have been told that they can determine the extent of the infection but I don’t recall how.

I found the below, regarding staging, on Dogaware
“Heartworm infection is divided into four or five stages (depending on the model used), based on the severity of the infestation and the age and health of the dog.

Stage 1 (mild) consists of young, healthy dogs with no symptoms and minimal changes evident on X-rays.

Moderate (stage 2) infection will show heartworm disease that is evident on X-rays, but symptoms are minimal, mostly coughing. Stage 3 is a severe infection, with weight loss, coughing, difficulty breathing, more damage visible on X-rays, along with liver and/or kidney damage.

Stage 4 and 5 are considered critical, with the dog often collapsing in shock. These dogs will not survive ordinary heartworm treatment, and must have the worms surgically removed if they are to have any hope of survival.”

Has he coughed at all? I did a QUICK google search and didn’t see anything linking shaking with heartworm disease. I did see “tremors” so googled “tremors heartworm”. All I got from that is side effects of preventatives.. May just be coincidental??

• This reply was modified 11 years, 4 months ago by Shawna.

[Shawna]

Dori,

I know many vets that recommend milk thistle just as you are dosing it.. Just thought I would mention losul’s findings — in light of everything going on…

• This reply was modified 11 years, 4 months ago by Shawna.

[Dori]

Shawna,

In light of everything that’s going on is exactly why I’m going to stop the milk thistle until I can get a better picture. I don’t want to think I’m already going against my feeling on heart worm 12 months of the year and then have the milk thistle interfere one way or the other.

I think what has happened with Turbo and Losul has been a real wake up call for me especially that I now live in the South. I was continuing to do what I did all my life living in NYC and NJ. I’m no longer going to do that. I’ve realized that what I was doing was basically playing russian roulette. I called my vet and told them how long I had stopped and he said to continue to give the Sentinel monthly and he’ll test all the dogs for heart worms in 6 – 7 months. At their physicals they were all fine and that since we have had such an unbelievable cold winter this year the probability is that they are fine but insists they be re tested in six to seven months.

[Dori]

Losul

I would definitely have X-rays done and ultrasound. I would want to know it all. The worst that can happen if all is clear is that you spent some money. Sure, it’s costly but not as costly as peace of mind. You’ll get a clearer picture. I know you’re vet said that most people don’t want to spend the money but, hey, it’s your money to spend. Both can be done successfully without anesthesia. I’ve had dogs in the past have both done with no anesthesia and my dogs are not of the calm variety. My Tibetan Terrier that we had was the most hyper of dogs we’ve ever come across and believe me, I have been mom to some real crazies but she was truly nuts and she did not need to be anesthetized for any testing. Just takes patience and a couple of good calm techs and is fine.

I’m not sure if I said at any point in my other posts but I agree with all that said to hold off on the rabies shot. Seriously, with Turbo going through these treatments I don’t think his body needs to be going through any more stress. He’s going to be either at the vet or at home resting so I don’t think he’s in imminent danger contracting rabies. Did he give you a valid reason as to why Turbo should get the rabies vaccine now?

[Shawna]

I haven’t used traditional heartworm preventatives for the past 19 years, am not now and probably never will. Even after knowing losul’s experience. I have a fantastic holistic vet, access to another AMAZING holistic vet, a dad that is a trained herbalist, products in my pantry that fight worms (including heartworms) along with a father that can help with dosing if I were to need it etc etc.. But I do understand why folks would chose the traditional preventatives.!!

[losul]

Dori there may be a quick way of getting at least some minor info. google maybe how ivermectin is metabolized in the liver, half life of ivermection. Millk thistle and drug interactions, etc.

grapefruit/juice also interferes with certain drugs metabolism.

Wish I had more time to research again. and i have a horrible way of organizing my stuff.

Don’t necessary change your milk thistle protocol because of something i said though, but I would definitely suggest researching it. I thought most vets did suggest waiting a short period of time before starting.

Shawna I don’t think he ever actually coughed before that I’ve ever noticed, I think He actually did once today, I was listening and watching very closely after that application, and I think that’s what it was. A gulping or belching maybe occaisonally. He does seem like he’s been much more of a couch potato lately.

I’m going to call the vet maybe gone awhile.

[Dori]

You are in a truly unique and enviable situation. Under those circumstances I would do exactly what you do. Unfortunately I’ve not been able to find a holistic vet here that I’m comfortable with. The holistic vet here in my area that has the best reputation prescribes cooking the dogs diet so obviously since it goes against what I have learned on this site about a raw diet and have seen the results with my own eyes, she’s not for me or my dogs. Traditional vet, of course, advises year round heart worm preventative. In the Northeast it was recommended for Summer not Winter. I’m afraid that mind set stayed with me. Living in the humid South I should have been preventing year round. You are lucky to have all those resources around you and your wealth of knowledge. Honestly, you’re like a walking talking encyclopedia. Love it!

[losul]

Don’t know why for sure Dori, maybe the law or liability, or who knows the the heck he was thinking. I’m not concerned about him getting rabies. I still have a concern that if I go elsewhere now that they may not treat him at all because his rabies shot expires today.

I was even researching that dreaded proheart6 last night, and I read that they reintroduced it with a warning oin the label to not administer within 1 month of vacinations.

• This reply was modified 11 years, 4 months ago by losul.

[losul]

My vets out of the office now until Wednesday, She said it would probably be Wednesday evening before he calls me back. They don’t really want to put me with another vet that doesn’t know the case. I guess the the X-rays, etc. , not exactly urgent immediately, but I do iwant them done.

[losul]

Dori Sentinel is milbemycin? (spelling?) I would think, but don’t know for sure if it’s metabolized the same in the liver as ivermectin. I believe they’re all in the same class of drugs though.

Also didn’t see before what how were dosing. A day or so after might be O.K. I definitely wouldn’t want to give it before, at the same time or too quickly after.

• This reply was modified 11 years, 4 months ago by losul.

[losul]

Dori, I found this with some googling. I don’t think ivermectin shows on the list but that list isn’t all inclusive. I’ m sure you can find that ivermectin is metabolized by the same CYP3A4 enzyme in the liver, probaly other drugs in it’s class also. I pulled that up somewhere before, probably from the manufacturer’s site. I’ll look some more whenever i can get a chance. Most of the drug interactions it increases the efficacy, while there are a few it decreases it.

http://www.hcvadvocate.org/hepatitis/hepC/mthistle.html

[Dori]

Thanks so much Losul and Shawna. I’ve been researching like crazy but I have to stop for a few minutes. Dogs and hubby are hungry. I will continue after dinner cleanup. Dr. Karen Becker says dose milk thistle for 7 days right after heart worm prevention if you must use it in areas of mosquitos (southern states year round). I have found other sites that contradict her thoughts. So far what I’ve come up with is “damned if you do and damned if you don’t”. I’ll continue research and report later this evening.

Losul. Ive continued to research your situation and the majority of the sites suggest x-rays and/or ultrasound. Some sites say at minimum due x-rays. Others say both. If you have the finances I’d do both. As someone with an autoimmune else (connective tissue muscles and skin involvement called Dermatomyositis) I’ve always been told that blood tests, x-rays and ultra sounds are the way to go by all my different doctors with all their different specialties) because X-rays will pick up some issues that ultra sound won’t and vice versa. I would assume that that is true with everything. As I say, if your finances allow it I would do both. But no judgment if you do neither. Trust your instincts, they usually work well by us. Also you have fabulous help in some of the posters, others, like myself just want to give you some moral support and prayers. As I’ve said before, Shawna and Aimee are real gems but in the end you’ve got to go with your gut. Listen to it, it serves us well.

[Dori]

Sentinel. milbemycin oxime/lufenuron/praziquantel. Dosing is every 30 days for the area of the U.S. that I live in. Even Dr. Karen Becker states that at Healthypets Mercola. She suggests milk thistle (has dose on her site) starting the day after for seven days. It’s all so confusing. Some say yes and agree with her and others state that it changes the efficacy of the Sentinel. Can increase or decrease it’s effects. Exhausting. I cannot imagine how you’re holding up. Make sure you keep yourself nutritionally well, you’re going to need it. You need to keep in good shape for yourself, family and Turbo.

[losul]

Thnx Shawna just saw your bloodwork reply, I guess we went to page 4 and I didn’t see. Seems like the pages were rolling by quickly. Sorry to be bombarding you with so many questions. Hope I haven’t missed others or from anyone else. I haven’t even looked much at the review boards over the last couple of days.

Those 2 items actually show within the the reference range, just at the high end of it. So I guess all that I have on it looks pretty good. I don’t know how complete it is though.

Actually and sadly i don’t have a past blood eval to go by, should it be done every year?

Yes I would appreciate Aimee, Patty, HDM and anyone else chiming in with any thoughts.

[losul]

Dori, yes I found the same thing, most sites heartworm sites discuss x-rays, ultrasound and even urinalysis, to determine extent. Thats why I couldn’t understand my vet not recomending them and had to call him back on those things. He can’t possibly judge with any certainty just by listening to heart and lungs, and his being asymptomatic. I thought that at the very least x-rays and bloodwork were essential in determining stage. And that’s why I worry that there could be more than it first appears.

[Dori]

I’m not Aimee, Patty, HDM or Shawna. Just me. Though I may choose to vaccinate in some areas and not in others, one thing that I always do is yearly blood work. In Hannah’s case (14 1/2 year old Maltese) I have blood work done every 6 months. In my estimation it’s very important. It’s the guide we have to go by. It’s just too dicey too let much time go by. I always go by what my dogs look like and their behavior but I need to trust blood work to catch anything going on internally. I don’t want to come late to the party if you get my meaning. I want to catch things earlier rather than later. I don’t do much vaccinating other than rabies (it’s the law and I do try to be a law abiding citizen….the 60’s flower child in me has somewhat left me) but there are so many other issues that can crop up undetected.

[Dori]

Again, Losul, I would insist on x-rays and ultra sound. Yes, doctors can listen to you with a stethoscope but can they REALLY know what’s going on with further testing be it x-rays, ultra sound or whatever. I can only go by what I go through myself with my medical issues but are we really so different than our furry family members. Not really. Not in diagnosing illnesses and the extent to which they have ravished our bodies or not. I certainly would not be content with a doctor holding a stethoscope to me listening to my heart and lungs and giving me a diagnoses. I want details. Some doctors are excellent and they still order tests. My doctor is head of his department at Emory Medical University Center in Georgia but he would still and always does order every test under the sun. X-rays, ultra sounds, CT scan, MRI’s. Funny thing is, if he made suggestions without further testing I would follow his lead. But, he’s been my doctor for this illness for the past 11 years and he was a student of my doctor at Cornell with I lived in NYC. Gottta trust your doctor (vet) or go with more testing.

[losul]

Please Dori, no offense, those were just the names Shawna asked in her post to which i was replying if they had any thoughts on the bloodwork, I think about the values, if it’s enough, etc.

Weird for me that vets never discussed yearly bloodwork with me. It might be because of my area, or I’ve been out of the loop for so long. They are always pushing the vaccines though. I’m going to try to be much more vigilant on everything going forward, no doubt. Thnx Dori.

[Dori]

OMG! Losul. It takes a lot to offend me at my age and my life experiences and I never took offense to anything you said or any advice you asked for. As I said, I’ve gone through a lot in my life at my age very little, trust me, offends me and it would certainly not be from someone who is genuinely seeking help for a loved one. Please don’t give it a second thought. It didn’t even occur to me to be offended. My life experiences could be coming from a unique experience as my son had been born with Hemophilia (spontaneous mutate when I was born) and at the age of 3 years old I took medical courses and took over his home intravenous infusions and then in 1997 I was diagnosed with an autoimmune disorder which I believe were due to going through enormous amounts of stress with my son, my mother was diagnosed at the age of 90 with ovarian cancer, and I was going through menopause all at the same time. Both my mother and my only child, my son, have since passed. I say all this to let you really know. No offense taken, just trying to help with whatever I can do.

[aimee]

When hwp were first licensed one dose after exposure would prevent infection. I think Heartgard and Sentinal are licensed that way. But we aren’t in Kansas anymore or maybe we never were : ) One dose post exposure isn’t always doing it. (Bayer tried to capitalize on this as one dose of topical Moxi prevented infection but one dose of ivermectin and milbemycin didn’t for the MP3 strain.) However, repeated doses of the preventatives DID prevent infection against those strains. When Trifexis was licensed it was licensed as 3 doses post exposure. I think this is because 1 dose didn’t meet FDA requirements but 3 doses did. Now the most recent HWP licensed, Sentinal Spectrum, is licensed as last dose 6 months post exposure.

I see this as different than resistance, I believe with the true “resistant” strains it doesn’t matter how many doses are administered, infection occurs. Hmm… I look at this kind of like the “slow kill” adult, one dose doesn’t do it but repeated doses does. This is why I do and will continue to give my dogs HWP for a min. of three months after the last possible exposure to heartworms. Giving doses multiple months post exposure isn’t about selling more preventative, it is about preventing more infections! Resistance of bacteria to antibiotics isn’t always all or none either. The bacteria may be resistant at dosage X but not at dosage Y

It is currently thought that the adulticide may not be as effective against young adult vs older adults which is why I think the current treatment protocol is to treat with prev for several months before the immiticide is given.

The Alkp and Alt are liver enzymes. Like Shawna it doesn’t surprise me to see a high end Eos count. I don’t know though that it has any predictive value.

[losul]

Sheez Dori, Im so sorry life has been so full of trials and tribulations for you. You must be tough as nails for what you have gone through yet i know you have have somehow remained a most beautiful caring person. Thank you.

[losul]

Thanks again for your input Aimee. It’s pretty much the way I reasoned it, have trouble putting into words. According to Dr Garner, and I don’t know how good his info is, he says is based on his experiences alone, most of the HWP’s will not normally kill even mid to late maturity L4’s. He thinks Moxidectrin fills the gap more than any other, even reaching into young L5’s.

Do you offhand see there is any other bloodwork I should have for Turbo?

[Dori]

Losul. I’ve learned from, as you called them, my trials and tribulations that if your not moving forward, you’re standing still. Looking back is not a good thing. What you could have done differently does not change the outcome that you are now living. All we have is the here and now which is why I’ve urged you to look forward optimistically and know that you are making the best decisions for yourself and for Turbo. Second guessing yourself at every juncture will not move you forward that will only keep you and Turbo at a stand still and that’s not of any help to anyone. I have a feeling that my knowledge of you from all your previous posts is that you’re a pretty together person and you know the path you think is right. Just take it and be well.

[losul]

Dori, I dwell too much looking back lately on a large number of things. thnx for the inspiration to look forward.

[aimee]

Honestly,

I think your vet is probably the one best to advise you as to which blood tests are recommended. If that is what he ordered that I’d say you are likely good to go! Glad to read that the advantage multi dosing went down without any problems today.

[losul]

Yeah, I guess he should. But the blood testing is what I picked out with his help before we even had any diagnosis of anything. I was looking for something causing his trembling. So I had the outside lab work, and the tickborne illness and heartworm check. After the HW came back positive, he never suggested doing any different outside lab bloodwork, and it remained the same as it was.

edit: That stuff is alot more liquid than i thought it would be, and the wet spot has spread farther than i thought it would, maybe 4 or 5 inches in diameter It’s still slightly damp., although I saw a little “dust” around the circumference. I guess it should completely dry soon. No apparent irritations or anything. Still really wish they’d have left the insecticide out of it.

• This reply was modified 11 years, 4 months ago by losul.

[losul]

Hello again Dori.

I wouldn’t EVER want to discourage milk thistle use in totality. I really do believe in it’s potent powers to protect and even help heal the liver. But it’s also because of these potent powers I think awareness/caution is warranted, and especially in regards to possible interactions with other drugs/botanicals, and under certain other circumstances.

I think the last time I looked into this, was well over a year ago. The bookmarks I had on it died with my last computer. It’s hard to get detailed and reliable info from anywhere but the manufacturers, as to actual expected half lives, exactly how the drugs are metabolized, etc. and am having difficulty getting that reliable info again. It’s also hard to get reliable studies on various herbs and supplements,

Going by other resources I think it can be established that ivermectin is primarily metabolized by CYP3A4 in the liver, and as far as I’m concerned, for me, there is enough evidence that milk thistle does inhibit CYP3A4, even though there are few studies as to exactly what extent, dosage rates, potency hard to be determined etc. on milk thistle or almost other botanicals/herb. Most sites I’ve seen, classify milk thistle as a CYP3A4 inhibitor of undefined potency, which would be usually be the case in unregulated and essentially non-standardized supplements. That study referenced in the link i posted the other day, implies relatively high inhibiting potency for milk thistle.

http://www.hcvadvocate.org/hepatitis/hepC/mthistle.html

Not sure exactly how milbemycin, moxidectin, is metabolized, but I would have to assume it’s much the same way as ivermectin, as they are all in the same class of drugs. Apparently ivermectin has a longer longer half life in dogs than i recalled, and milbemycin a little longer than ivermectin. But these, when given in oral dosages, are at least predictable as to their peak plasma concentrations, especially when given without a meal, it’s within hours. Because of the slowed release method of topical moxidectin, peak concentration times for that cannot reliably be determined, I’ve read anywhere between 8 to 21 days after dosage. I would have liked to have incorporated milk thistle into Turbo’s regimen at some point, but as of now, I don’t see how i can confidently do that using moxidectin, and what i don’t know yet about moxidectin. Because all these HWP’s are in the same class of drugs, for now I have to assume they are metablized much in the same way as ivermectin.

If a medication has an expected half life of 24 hours, it doesn’t mean the medication will be cleared in 48 hours. It means that every 24 hours the remaining plasma concentration should be expected to be divided by 2.

I suspect that most advice for milk thistle is for very low dosage, only once a day, and after a reasonably safe time period, at least a day or two after HWP administration? Given in that way, I wouldn’t think there would be significant alterations in elimination time or efficacy, However, I wouldn’t listen to any advice that says to give it before, concurrently with, or immediately after any HWP. Nor any loading up on dosage of it. Additional precautions should be dogs with the defective/suspected defective MDR1 gene, which are already much more susceptible to these drugs crossing the blood/brain barrier, dogs on certain other drugs, or are being given high doses of ivermectin, or the others.

“Dogs with defects in the P-glycoprotein gene (MDR1) can be severely poisoned by ivermectin.”
“Since drugs that inhibit CYP3A4 enzymes often also inhibit P-glycoprotein transport, the risk of increased absorption past the blood-brain barrier exists when ivermectin is administered along with other CYP3A4 inhibitors. These drugs include statins, HIV protease inhibitors, many calcium channel blockers, and glucocorticoids such as dexamethasone, lidocaine, and the benzodiazepines.[21]”

http://en.wikipedia.org/wiki/Ivermectin

Note: I think ivermectin and other like drugs given in the low dosages as given normally for heartworm protection, are usually considered safe for dogs with the defective MDR1 gene, unless other factors come into play.

The only time I would ever consider loading up on milk thistle for a dog is if poisonous mushroom ingestion is strongly suspected or in acute aflatoxin poisoning. In which case, high dosages could save the dogs liver and it’s life.

[losul]

Just some info bits i’m picking up here and there;

Pharmacokinetics of Milbemycin Oxime
After oral administration to dogs milbemycin oxime is quickly and almost completely absorbed. Peak plasma concentration is reached 2 to 4 hours later, and subsequently declines with a half-life of 1-3 days. Bioavailability is about 80%.

In rats, metabolism seems to be complete, since unchanged milbemycin oxime was not found in urine or feces. High concentrations of milbemycin oxime are found in the liver and in body fat.

As a general rule, due to a different pharmacokinetic behavior the anthelmintic effect is longer for milbemycin oxime than for ivermectin, although this strongly depends on the delivery form and the administered dose.

http://parasitipedia.net/index.php?option=com_content&view=article&id=2673&Itemid=3005
—————
WARNING: Dogs of some breeds are sensitive to milbemycin oxime, other macrocyclic lactones or other drugs (e.g. emodepside) that can cross the blood-brain barrier. They can suffer more or less serious adverse effects if treated at dose rates higher than the recommended ones. Consequently dosing must be as accurate as possible. This is the case for Collies and related breeds, which have a mutation in the MDR-1 gene that affects the blood-brain barrier and makes it more permeable to such compounds than in dogs without this mutation. Besides Collies, other dog breeds have shown similar problems, although the MDR-1 mutation has not been confirmed in all of them. The breeds more affected by this mutation are (% frequency): Collie (70%), Long-haired Whippet (65%), Australian Shepherd (50%, also mini), McNab (30%), Silken Windhound (30%), English Shepherd (15%), Shetland Sheepdog (15%), English Shepherd (15%), German Shepherd (10%), Herding Breed Cross (10%). Other less affected breeds are: Old English Sheepdog, Border Collie, Berger Blanc Suisse, Bobtail, Wäller. The only way to be sure that a dog is affected or not by the MDR-1 gene defect is to test for it. As more dogs are tested it is likely that the mutation is discovered in other breeds, or that the frequencies change. Besides Collies, other dog breeds have shown similar problems, although the MDR-1 mutation has not been confirmed in all of them. The breeds more affected by this mutation are (% frequency): Collie (70%), Long-haired Whippet (65%), Australian Shepherd (50%, also mini), McNab (30%), Silken Windhound (30%), English Shepherd (15%), Shetland Sheepdog (15%), English Shepherd (15%), German Shepherd (10%), Herding Breed Cross (10%). Other less affected breeds are: Old English Sheepdog, Border Collie, Berger Blanc Suisse, Bobtail, Wäller. The only way to be sure that a dog is affected or not by the MDR-1 gene defect is to test for it. As more dogs are tested it is likely that the mutation is discovered in other breeds, or that the frequencies change.

http://parasitipedia.net/index.php?option=com_content&view=article&id=2673&Itemid=3005

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This is only referring to humans, and they don’t mention anthlemintics here, most people don’t use dewormers though.

“Inform the doctor if you are also on anxiolytics, antipsychotics, anticoagulants, anticancer drugs, statins, and seizure prevention drugs, as most of these are worked upon by some major hepatic enzymes and thus, milk thistle might disrupt their course of action.”
http://www.buzzle.com/articles/milk-thistle-dosage.html

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A bit on moxidectin

Pharmacokinetics of Moxidectin
After absorption into blood moxidectin is well distributed throughout the whole body including target organs such as the gastric and gut mucosae. The highest concentrations are found in body fat that acts as a depot from where it is progressively released to blood. Moxidectin is more lipophilic than ivermectin and consequently it is stronger deposited in body fat, which results in a higher residual effect and a longer protection against several parasites than ivermectin (by comparable delivery form and administered dose).

http://parasitipedia.net/index.php?option=com_content&view=article&id=2669&Itemid=3008

[losul]

Update; There is no noticeable greasiness or anything remaining on Turbo’s fur. can’t tell it was there.

Having some difficulty taking out on leash. yesterday the ice was thawing and I didn’t get more than a few steps in the yard, one foot went one way the other the other way. Muddy mess. Turbo amused I think.

Turbo is normally calm in the house, but when i get the collar and/or leash he gets way overexited. Today especially. Another good reason to get X-rays to try to help determine his current exercise restriction neccesity.

Th vet called me this evening, I told him about what Merial had told Dori. We agreed X-rays could be helpful, will call and set up tommorrow.

I told him that I had already received a rabies vaccination reminder in the mail from them. He reiterated not to worry, they have several dogs that they refuse to vaccinate even when the owner wants it done.

That’s it for now.

[Dori]

Hi Losul. First, how’s Turbo doing and have you been able to calm down a little? I hope so.

I really appreciate that in the midst of what you’re going through you’ve taken the time to get info for me and pass it along. I came out at the same conclusion that you did but you have no idea how gratified I am that they are your findings also. I’ve been doing a lot of research also on the different HW meds since Turbo was diagnosed and decided that since I have to do something, and living in the South, I will do it all year long long.

I do have another issue that I’m really taxing my brain over. I know a lot of you don’t like the idea of HW med that includes the flea ingredient. But living here in Georgia we have a lot of mosquitos, and fleas. Because we don’t normally get cold freezing weather for enough days in a row (this winter being the exception) nothing, and I do mean nothing, seems to die. I’ve gotten mosquito bites myself in the dead of Winter here. Fleas are pretty much a year round thing. Ticks? Not so much. I need some thoughts on my situation and my girls. Do I go with just the HW med or HW and flea? I’m mostly concerned about Katie getting flea bites with all her allergies she would probably have a pretty bad reaction. Good Lord! I sometimes feel this will never end. I go to sleep thinking of all these issues and wake up with the same thoughts wondering “Did I actually fall asleep?” or has these been some really long nights. Of course, if it’s not only these issues then there’s the food issues (allergy dog to food and environment, scents, you name it she can’t handle it). Then there are the supplements. Katie has started scratching again, no change in food, no fleas or anything on her. I started removing supplements one at a time for a couple of days and it seems she’s not doing well with the Mercola digestive enzymes. The other two are doing fabulous. I didn’t know they could have a reaction to digestive enzymes. I swear this little girl is going to have me pulling out what little hair I have left. Shawna referred to Katie as a delicate flower. I wish those were my kind thoughts of Katie. But she’s so damn cute, sweet, and with all her issues she’s just the happiest “go with the flow” little girl I’ve ever had the pleasure of having in my life. Not to mention it was because of her that I found this site (whilst pulling some hair out, mine, not hers) and my other two girls have been the beneficiaries of this fabulous site and my goto fabulous/wealth of knowledge posters. Thank you again for being so caring not only about your dog but all dogs. Some of you posters are so amazing.

[Dori]

Forgot to mention I’m glad your getting x-rays taken. If it shows nothing then that’s another thing to check off the list. Finger’s crossed. Thank God Turbo’s young and healthy. I think he’s going to be just fine. I’ve been reading a lot about Turbo’s condition and apparently HW is quite treatable and there have been more successes than not. The ones that were not successfully able to be treated were starting out with other underlying conditions and/or old so organs were already compromised.

[losul]

Hi Dori, I’m doing a little better, thnx, and Turbo’s O.K.

My agony peaked when the hard realization came that it was my fault, I already pretty much knew it, but I think it helped to finally get it out. It’s been a little more uphill now.

The fleas, i don’t know what to say. You’re situation with the fleas/insects in the area, and having several dogs is different than mine. Shawna and the others could suggest some alternatives vs. using chemicals, if you can or want to go that route. I don’t really know what I would do for sure in your situation.

I don’t use anything on turbo at all, haven’t had any problem with them here. I didn’t intend to use anything on him at all, but he’s already got insecticide on, or in him, now from the advantage, and I hate it that fact. I can’t really see keeping him on this very long because of that. I always figured if fleas become a problem here, I would only deal with them then, but not before. I know we have/had chiggers in the yard, several years ago, I had a bout with them, itching badly for several weeks. Never had a problem though on Turbo knock on wood. We have alot of ticks here, but again i don’t use anything on Turbo except some body checks, and I wasn’t always diligent about it. I only found I think 2 crawling ticks on Turbo this past season, until that last embedded one him that somehow survived through several bouts with hard frosts and cold weather, and I didn’t find until after it had been feeding for several days. I found more ticks than that on myself, seriously. Maybe some of them were crawling off Turbo and on to me. I hate it that he got worms, and now I hate that i have to give him all these harsh chemicals to try to make them go away. I think Turbo is young and healthy enough to come through it, but I still worry about damages and longer term consequences.

X-rays are set up for next week, and I agree, they will definitely be worth having done.

Hang in there with Katie, i think your determination will get it all figured out!

[theBCnut]

Hi Losul

Several things
The bloodwork is exactly where I would expect it to be and the most important thing is those liver enzymes. He should have no problem with treatment, since his liver function is normal.

I can’t find the thread that I’m looking for on another site, but the consensus was that you should wait 3 days after ivermectin to start milk thistle, no opinion on others because it was specifically a thread about using ivermectin that turned into a thread about using milk thistle.

The heartworm infection still could have occured before you got Turbo depending on when the heartworm tests actually took place and what kind of tests they were.

The load should be light because you/your vet are seeing no other signs. Ultrasound would certainly be more diagnostic as far as being able to see the worms and whether they are causing a heart murmur(if your vet didn’t hear one), enlarging of one side of the heart, filling the pulmonary artery, etc. only if they have high quality, up to date equipment and are good at interpreting what they see.

If the xray looks normal, then I probably wouldn’t do an ultrasound, and I would assume a light load of worms. But if the xray showed any changes, I would want the ultrasound too.

[Shawna]

Patty — I very much appreciate your natural and holistic approach combined with your schooling and hands on experience!!!!

Losul — I agree with Patty.. This infection could be quite old, even predating you adopting Turbo. Prior to this, have you had Turbo heartworm tested since getting him? Even if he got them under your watch — I think blaming yourself is a stretch.. How many of us didn’t know about the potential issues with refrigeration? I certainly didn’t. And many people read that you split the dose and no mention of problems. Even when I mentioned it, I wasn’t 100% certain. Just a vague memory.. And if heartworm in your area are ivermectin resistant, well you certainly can’t blame yourself for that!!

I had a foster puppy that was 1/2 Boston Terrier and also definitely had some bully in him.. Everyone who saw him thought pitty, especially Staffordshire. He came to me, with his mommy, when he was only 4 days old. His eyes were still shut.. He was such a little monster, so head strong and SO smart. He was the only foster dog that escaped the 4×4 enclosure I made for them (2×4’s and plastic chicken wire). In the enclosure I had an open crate, water bowl, potty pad, blanket etc. Came home one afternoon to find him terrorizing the other dogs in my bedroom with a little hole large enough for his little body in the plastic wire.. Little turd!!! I don’t have any good pics of the little guy with me but I’m going to post a not so good one on the blog here in a sec. Full grown my little guy is about 30 pounds too.. Weird huh…

[theBCnut]

If Turbo was tested within 6 months of getting him and this is the first time since then that he was tested, I would strongly suspect that he already had heartworms but was not far enough along to test positive. Many, many times a year, we got dogs in that had come from the shelter and had tested negative, but 8 months later they turned out to be positive after all.

I corresponded with someone who claimed to work at the plant where Heartgard was made. They said that the ivermectin and the meat paste carrier are mixed in a vat then pressed into molds of the appropriate size. That tells me that other than not giving enough or allowing air to spoil the meds, splitting should not be a problem. Example, if I have a 35 lb dog and a 15 lb dog, I should be able to split a chew for a 60 lb dog into thirds and give one dog 1/3 and the other dog 2/3 and it should be fine as long as I can split them accurately. I should not save some for the next month though, because the drugs could oxidize. The vet and the company make more if I have to buy a pack of the appropriate size for each and since it is a prescription drug, the laws don’t allow sharing anyways, but trimming off excess should not make the whole dose ineffective. My dogs weigh 42 lbs and usually I have to buy drugs for 60 lbs. Trimming off 1/4 should still leave enough drug for a 45 lb dog, but if it is a drug that comes in sealed pods/blister packs, I assume that it should be kept away from oxygen until use.

[Shawna]

Hi Patty,

Dori actually contacted them and was told this
“Hi losul and Shawna, I just spoke with tech support at Merial makers of Heartgard and was told that the ENTIRE dose must be given. You cannot split in half because they can not guarantee it’s efficacy. It is suggested that you not do that.”

Of course they would not suggest splitting doses for reasons other than efficacy. I just remember reading somewhere that to use a compounding pharmacy versus splitting the drug if pup is at the low end of dosing..

I did a quick google search and Mary Straus agrees with you and with Dori. “The issue of splitting heartworm pills comes up frequently. I have spoken to representatives from Merial (maker of Heartgard) and Novartis (maker of Interceptor). Both said that the active ingredients are mixed into their products before the pills are formed, and therefore should be evenly distributed (though they cannot guarantee this). However, both manufacturers advise against pill splitting.”

So maybe not splitting is just a precautionary recommendation. In which case it is unlikely the splitting would have been an issue.

[Shawna]

Good point about not saving the split pill too!!!

[Author]

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